I read about an idea for a wireless home-monitoring network for recuperating hospital patients. Apparently if someone can come up with a basic prototype there????????s money in VC circles available to pay for it.

Here????????s the relevant snip from the article:

WHAT THEY WANT: A wireless home-monitoring network for recuperating hospital patients.

WHY IT’S SMART: No one likes extended hospital stays. Not patients, not hospitals, and not insurance companies paying bills that can exceed $5,000 a day. For the critically ill, there’s no way around lengthy visits. But thousands of other patients could be sent home early if they could be monitored at home or at a lower-cost facility. Badawi and Aslin envision a wireless transmitter that would attach to existing hardware such as portable ECG machines and heart-rate and blood-pressure monitors. The device would send data through a wireless router to a cluster of back-office servers. The servers would function like a call center, routing a patient’s vital signs to the right nursing station or on-call physician. Trimming just two days off the typical 10-day hospital stay for stroke victims would be a service worth $2.7 billion.

WHAT HE WANTS FROM YOU: Between you and a partner, you’ll need expertise in medical device technology and database management to get a working demo ready to pitch to HMOs or insurance companies. Half a million dollars in seed money should be sufficient to get that far. “It’s not the technology, it’s the complexity of navigating the health-care system that’s going to be difficult,” Badawi says. If you can sign up an HMO to test the system, 3i promises $7.5 million more to bring it to market.

Anybody think this idea has a great deal of value? I know many of my readers are CIOs and technologists within healthcare and healthplan providers. Specifically, if the service were available, would you purchase it? What would it be worth?

Christina over at Christina’s Considerations writes about Personal Health Records. She points out Medem’s new iHealthRecord site, which seems like a great PHR initiative. This PHR competes with the likes of OnFile, MyMedicalRecord.com, MyPHR.com, and numerous others. The market is not starting to mature yet because the initial players are still basically throwing darts at the wall to see what’s sticking.

Until a “name brand” PHR appears (like mysuggestion for American Red Cross to become a player) we’ll continue to see widely varying implementations. As soon as the big players enter and we see some consolidation we’ll get some really good economies of scale.

By the way, the winners may not be chosen because of the size of vendor but the size of customers using it. For example, if IBM picks a PHR for its employees and few other Forturne 50 companies do so, it will drive a vendor’s success. Other factors that will drive vendor success will be if health plans pick up their service. A PHR chosen by AARP may be the biggest beneficiary.

Check out RxWise. It’s supposed to analyze your medical history and help prevent interactions between prescription, over-the-counter and herbal medications, including drug allergies. You manage all your meds online (yourself) and then your pharmacist and docs can be given access so that it helps reduce prescription errors.

There is also an option to get a USB thumb-drive type device. Here’s what they say about that:

If you sign up for the Flash Drive version, we????????ll send you a thumb-sized USB Flash containing all of sophisticated, yet easy-to-use risk-assessment software. If you choose the web-accessible version, we????????ll email you a temporary Username and PIN to launch the application and then you can create your own personal and secure Username and PIN. You, your physicians, and pharmacists can use either version along with your self-reported medical conditions and medication usage, to check for:

From now on, the Composite Health Care System II (CHCS II) is to be called AHLTA. DOD officials said AHLTA stands for Armed Forces Health Longitudinal Technology Application, however, the system should simply be known by the acronym.

Winkenwerder said he did not like the CHCS II name because it suggested that the system was not No. 1. AHLTA, which will hold the health records of 9.2 million military personnel, family members and retirees, will be one of the largest and most advanced health information technology systems.

The CHCS II system has been in development since 1998 and despite over $1 billion in costs it has yet to see even 50% deployment. Now with the name changed to 5 letter acronym it’s going to be smooth sailing, though .

Splunk automatically organizes various types of IT data (logs, configuration files, message queues, JMX, SNMP and database transactions) into events. It then classifies these events and discovers relationships between events of different kinds. Events are indexed by time, terms and relationships. It then tosses on a search engine so you can look for patterns in realtime or much later.

Now, healthcare IT builds on top of regular IT so Splunk is a fascinating product for HCIT purposes and you should look at putting it to use as is. It’s bound to save you time and support costs.

However, what if we took the same concepts in Splunk and applied them to fast-moving medical information? Could we do event-based tracking of unstructure clinical trends data? Could we take what Splunk does and feed it HL7 or X12 data and get meaningful results?

RSS is a means to syndicate content unidirectionally — for example, when I create a new article here and you subscribe to my feed you will get news about my new publication in your feedreader. Microsoft’s Ray Ozzie (inventor of Lotus Notes and Groove) announced that Microsoft has extended the standard with SSE, which is a ???????specification that extends RSS from unidirectional to bidirectional information flows.?????? Some elaboration on the technology comes from Ray:

For example, SSE could be used to share your work calendar with your spouse. If your calendar were published to an SSE feed, changes to your work calendar could be replicated to your spouse????????s calendar, and vice versa. As a result, your spouse could see your work schedule and add new appointments, such as a parent-teacher meeting at the school, or a doctor????????s appointment.

SSE allows you to replicate any set of independent items (for example, calendar entries, lists of contacts, list of favorites, blogrolls) using simple RSS semantics. If you can publish your data as an RSS feed, the simple addition of SSE will allow you to replicate your data to any other application that implements the SSE specification.

SSE can also be used to extend other formats such as OPML.

After thinking somewhat about the technology (which is described by a draft specification and elaborated on by an FAQ) I think it can easily be applied to the medical record and biomedical information synchronization problem inherent in healthcare IT. What we’ve needed is a really simple and ubiquitous synchronization protocol and while SSE still has to prove itself, I think it may work. The problem is that it won’t be transparent in legacy applications (the applications would need to know about SSE to utilize it) but all healthcare IT application managers should look at SSE and see how it might be applicable to their environments.

Lets see how it might work: assume that the scheduling application you bought has been upgraded to use SSE. Then, whenever anything “new” happened (an appointment was added, an appointment was cancelled, etc) anyone subscribing to the SSE feed would be notified and update their own information based on what’s new (and send back their affected changes). Assume that a medical record in the labs department was updated — a synchronization message could be sent using the protocol and the medical record in another department could be updated, and if anything required change propogation then the message would respond with its changes.

Now, in real life things are much more difficult than I’ve alluded to here but we’ve got to start somewhere. What if SSE could be used to carry payloads (attachments) of HL7 and X12 data? Then we could have the best of both worlds: RSS, XML, SSE for synchronization publish/subscribe and broadcasting while the messages themselves stay similar to what they are today. We still have to work out the sematics and homogenization problems but that’s a different story.

If RSS, XML, and SSE can be used together they would form a potent combination of the basic protocols necessary for synchronizing data (with some semantic meaning) across medical and clinical systems without every system having to use a centralized database (a holy grail no less).

It’s time to put your thinking caps on and talk to your vendors to see how they can help some of these modern, but very very simple, protocols to help alleviate some of the medical information sharing burdens that are shouldered by the healthcare IT community.

Oh, by the way, SSE is open source. It’s published under the Creative Commons license.

There’s a related SSE won’t work column over at Daily Buzz. I don’t agree with him completely, but he’s got some good points. What I don’t agree with is that all the problems he cites has to be taken care of in the spec — it’s possible to get started and use it for simple synchronizations and replace proprietary means. Then, as the spec grows it will become more useful for general sync.

Most of the medical community is probably not terribly interested in podcasts yet but I suspect that digital recordings that many physicians make for medical records can be turned into transcriptions and easily inserted into medical records using upcoming services like Enablr’s Transcribr. Now, they’re not super-cheap, but the idea is great (especially for $1 a minute which is cheaper than many full-service bureaus). Aswe already know, transcriptions in the medical/clinical world are some of the largest portions of healthcare budgets so anything that can help reduce that cost and burden will be more meaningful than new software.

Here’s what I think a new company, similar to Enablr, could offer — you digitize your medical chart note into a podcast format (mp3), which these days is pretty easy and getting easier, and they’ll watch the podcast streams and transcribe them automatically (sending back the data in a meaningful way attached to a record and in printed form).

Of course, the biggest problem will be security and privacy management but that could be worked out easily if there’s a big enough market. Today podcasts are designed for open reading and subscriptions (for money). But, if we could design a secure way to upload a file and using standard technologies (nothing proprietary) we could any service that offers podcast transcriptions and make transcriptions are commodity that we could switch vendors to/from easily.

Now, why would this be useful? Because if podcasts that are created for medical records could be tagged with a patient ID then almost everything else could be automated. As soon as a dictation is finished, just upload the file and it will be automatically transcribed and attached. Nice.

By the way, modern digital dictation tools (like the Olympus WS-100 I use) are already USB devices and taking a file and dropping onto your computer is trivial now.

Indoor Positioning Solutions (IPS) is analogous to GPS in an indoor space. The folks at Radianse combine active-RFID and location information to enable systems, applications, devices and clinical spaces to automatically initiate actions based on circumstances or events at a point in time.

Here are some of the things they claim can be done with their system:

Real-time asset location ???????? right equipment in the right place at the right time

Improved preventive maintenance/recall management

Reduce time searching for equipment

Improved cost capture

Information on utilization rates

Rental and lease reduction programs

They say they can also help keep track of people to:

Reduce risk for ambulatory patients

Improve flow times with accurate measures

Increase staff security

Improve satisfaction

Spend more time with patients

Seems like very nice stuff. They recently presented to our Washington HIMMS chapter and their briefing is available online. I can think of lots of other uses for this technology. More on that later.

If you’ve been intrigued with the offshore outsourcing movement in the software development industry (such as R&D and operations/maintenance going to Ireland, India, and China) then you’re not alone. With everyone in healthcare IT looking to cut back on costs, it’s only natural that CEOs, CFOs, and CIOs would start to entertain offshore outsourcing options.

But, where do you start? Who can you trust?

I’ve been using an auction-style service known as RentACoder. Their business model is simple: if you need software related work done you create an account, describe what you want done, and within 24 to 48 hours you will have a bunch of developers from all over the world bid on your project. You take your time to decide on what you want and RentACoder (RAC) will provide ratings, previous work history, etc. Once you’ve selected a “coder” RAC will escrow the project funds and tell the developer to initiate work; during the project you can keep contact directly with the developer and through the RAC website’s messaging system. Their website isn’t the friendliest in the world and the messaging system is a bit difficult but if you dispute anything they want you to document it through their system to ensure non-repudiation.

Once you’re happy with the work the developer does RAC will release your money from escrow — if there are any disputes, they’ll help resolve them. And, best of all, it doesn’t cost you anything other than the project work (the developers pay RAC from their fee). And your money is generally safe since RAC is Florida-based (you’ll have someone local to sue if necessary).

I’ve used RAC successfully now for many months and have completed many small projects. Although I’ve not done anything medium- or large-scale with it yet, though. Like most offshore work the communications process is critical: if you can’t fully describe what you need done and don’t stay on top of the work on a regular basis you’ll get unexpected results. The value of the output is directly proportional to your specifications and management time. The more you give, the better the results. The less you give…well you get what you pay for!

The one thing I was worried about originally was that US-based healthcare IT experience offshore is hard to come by; and, yes, people offshore don’t really understand how our US-based models work. But, with proper specifications I’ve been able to get around many of the industry knowledge issues. But many still remain. Again, it’s all about communications.

I recommend most of you at least give it a shot — it’s possible that it will save you some money (but not necessarily time). If you learn the system it can save you lots of money. Assuming you know exactly what needs to be done (nothing really innovative) RAC can probably save you 50% off your project costs but will take a little longer to finish. If you don’t spend decent time on specifications, though, it’ll end up taking more time and more money than doing it locally.

Once you give them a try (or if you’ve already tried them), let me know how it goes.

A friend of mine recently sent a link to an interesting article on RHIOs.

From the Journal of AHIMA, Real-World RHIO: A Regional Health Information Organization Blazes a Trail in Upstate New York. Their description:

By distributing costs and benefits among providers and payers, a regional physician association is creating a data exchange network with an ambitious goal: interoperable EHR systems in every physician????????s office.

You may also be interested in these sepcial IDC reports on RHIOs and RHIA guides: